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General NPI Number Information
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NPI Number | 1770568701
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Entity Type | Individual
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Provider Name | DEBORAH R MCMULLEN PCC-SC, LICDC, LSW
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Gender | Female
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Dates
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Enumeration Date | 12/13/2005
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 5727 ROWENA DR
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City | DAYTON
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State | OH
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Zip | 45415-2445
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Country | US
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Telephone | 937-361-4834
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Fax | 937-588-5877
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Provider Business Mailing Address
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Address Line | 5727 ROWENA DR
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City | DAYTON
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State | OH
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Zip | 45415-2445
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Country | US
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Telephone | 937-361-4834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 021106
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | S 0004990
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 3747P1801X
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Taxonomy Name | Personal Care Attendant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | E 0002479
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License Number State | OH
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